Multicampus Outbreak of HIV in North Carolina Spurs Quick State Action: Prevention, Testing Program Targets Black Colleges

A North Carolina HIV RNA screening program, the Screening Tracing Active Transmission program (STAT), recently uncovered an HIV outbreak among college students, particularly young black men who have sex with men, attending 11 predominantly black colleges and one Native American college. Experts from CDC are investigating to determine effective intervention strategies, said Lisa Fitzpatrick, MD, MPH, CDC medical epidemiologist.

"Another reason this investigation is important," Fitzpatrick said, "is because it will highlight the critical need of health resources in the South."

Between 2001 and 2002, HIV infection increased 9.6 percent in North Carolina. From 2002 through September 2003, HIV rose 5 percent, said Evelyn Foust, MPH, head of HIV/STD Prevention and Care for the state Department of Health and Human Resources.

Lisa Hightow, M.D., M.P.H., infectious diseases fellow at the University of North Carolina-Chapel Hill, and co-investigators found that 40-50 percent of new N.C. HIV infections occurred among people younger than 25, with a significant percentage among college students. Twenty-five of 146 newly infected men in North Carolina attended 11 colleges, and a sexual network linked seven campuses. Eighty-eight percent of the men were African-American; the same percentage were MSM.

The outbreak was discovered because North Carolina health officials instigated a novel blood-screening procedure. In November 2002, the state began RNA screening on blood samples from STD and HIV clinics, counseling and testing programs, Foust said, to detect acute infections. Launched as a pilot program, STAT is the only such state program in the nation.

"Had we not been doing testing for acute HIV infection then, we might not have discovered [the outbreak] for a year or two," Foust explained.

The state and the affected colleges are collaborating on Project Commit to Prevent to provide peer education training for HIV counseling and testing. Public health officials also plan to implement changes suggested by CDC after the investigators complete their research and report.

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